Report Examines HIV Trends Among Civilian Applicants for Military Service

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HIV seroprevalence among civilian applications continues to decline with rates in 2012 at their lowest level since the U.S. Armed Forces began testing civilian recruits for the disease, according to a new study.

During the 18-month period from January 2012 to June 2013, 540, 914 tests for antibodies to HIV were performed on 519,723 civilian applicants for U.S. military service, according to the study published in the Medical Surveillance Monthly Report, a peer-reviewed journal on diseases and illnesses affecting service members from the Armed Forces Health Surveillance Center. Of those tested during this period, 101 were found to have antibodies to HIV (seroprevalence: 0.19 per 1,000 persons tested). From 2008 to 2012, annual rates declined 53 percent from 0.49 per 1,000 persons tested in 2008 to 0.23 per 1,000 persons tested in 2012.

The seroprevalence was higher in males than females in every year of the surveillance period. The seroprevalence rate among males decreased by 52 percent from 2008 to 2012; among female applicants, annual seroprevalences declined 65 percent. As in every year in the surveillance period, in 2012 the seroprevalence of HIV was higher among black, non-Hispanic applicants (0.88 per 1,000 persons tested) compared to Hispanic/other applicants (0.12 per 1,000 persons tested) or white, non-Hispanic applicants (0.08 per 1,000 persons tested).

In black, non-Hispanic applicants, HIV seroprevalence decreased 49 percent from 2008 (1.79 per 1,000 persons tested) to 2010 (0.91 per 1,000 persons-tested) then remained stable from 2010 through 2012.

Civilian applicants for military service are screened for antibodies to HIV during preaccession medical examinations. Infection with HIV is medically disqualifying for entry into U.S. military service. All service members have been screened as civilian applicants for military service since 1985 and routinely every two years since 2004. In addition, pre- and post-deployment (90 days) screening has been a standard requirement for over a decade

Among U.S. military service members, trends show that, after a few years of declines in all U.S. military services, incident cases have recently shown a slight rise. The only services spared this trend are the Marine Corps active and reserve components, the Air Force active component, and Coast Guard active and reserve components. Across all services, increases in HIV infection rates are attributable to male service members.

High-risk sexual behavior among some military service members remains an important target of efforts through education and prevention programs to reduce the incidence of new HIV infections. The highest-risk sexual behavior for transmission of HIV is engaging in unprotected sex (i.e., without condoms) with an infected person. Other behaviors that compound the risks include engaging in unprotected sex with more than one sexual partner or with a partner who has other, concurrent sexual partner(s). Binge drinking has also been associated with unsafe sexual practices. The probability of transmission by blood transfusion is very low.

Experts have pointed out that the military presents challenging conditions to consider
when addressing HIV education and prevention strategies. To begin with, the U.S. Armed Forces contain a large number of high risk age group individuals, i.e., those under the age of 25. A major challenge is presented by the complex ecology in theater – multiple social communities and a high risk environment which fosters risky behaviors in some service members.

Efforts toward education and prevention can be enhanced to address disparities in racial and ethnic groups, and these same efforts should continue even in deployed conditions, the study noted.

Source: Armed Forces Health Surveillance Center (AFHSC)

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